CCLP HEALTH PROGRAM'S 2012 LEGISLATIVE SESSION REVIEW
With the 2012 legislative session drawing to a close, the Colorado Center on Law and Policy reflects upon how well the General Assembly advanced the ability for Coloradans to achieve access to high quality, affordable health care. All things considered, CCLP declares the session a relative success on the health care front.
Legislation that was the focus of the CCLP health program’s attention this session fell into five categories: help for the uninsured, Medicaid defense and reform, health care access, the budget, and federalism. At least one worthwhile piece of legislation died on the House calendar, victims of the political wrangling on the eve of sine die. However, CCLP celebrates with its partners a huge success with the passage of the Hospital Payment Assistance program that will help working families to pay their hospital bills responsibly and avoid bankruptcy. We are disappointed in the Medicaid versus education tone and rhetoric that dominated budget discussions; however, CCLP acknowledges the successful passage of a budget that preserves past gains in coverage, makes new efforts to contain costs through payment reform, and finally makes a significant investment in the ailing CBMS.
Help for the Uninsured
SB12-134, Hospital Payment Assistance Program (Sen. Aguilar/Rep. Acree), passed and was signed into law. The act helps working families who cannot afford insurance responsibly pay their hospital bills and avoid bankruptcy. This was the health program’s primary proactive effort this year. CCLP helped to conceive, draft, negotiate and support this legislation. The bill was necessary for several reasons. First of all, uninsured patients are not always able to find information about and apply for hospital charity care policies. Moreover, uninsured patients, who do not have the bargaining power of large insurance companies or public programs, are charged much higher prices for hospital care than those with insurance. Public programs and private insurers negotiate lower prices with hospitals. Uninsured patients are the only group that pays the full listed prices for hospital care. These higher prices are a significant hardship for working families that already struggle to afford medical care, forcing many patients to go into debt, or even declare bankruptcy. The “Hospital Payment Assistance Program” addresses these issues by:
- requiring hospitals to adhere to transparency standards regarding hospital discount policies, including posting and including charity care policies with hospitals bills;
- regulating debt collection practices by requiring hospitals to offer uninsured patients under 250% of the Federal Poverty Level a reasonable payment plan and waiting until at least thirty days after the first late payment before sending them to collections; and
- limiting the price that can be charged to uninsured patients below 250% of the Federal Poverty Level (annual income of $72,050 for a family of four) to the lowest discounted rate charged to a private payer.
Medicaid Defense and Reform
SB12-018, Alternative Medicaid Program for the Elderly (Sen. Lundberg), failed. CCLP opposed this bill that would have required the state to seek a federal waiver to permit people in Medicaid to exchange 30% of their program benefits for a choice of providers and an exemption from Medicaid estate recovery. Senator Lundberg has offered a version of this concept each year for the past several years. The proposal invites Medicaid participants to forego care and puts them and their families in a very difficult situation in the event that they incur extraordinary expenses. CCLP has opposed this bill every year that it has been introduced.
SB12-032, Medicaid Reform Seek Federal Waiver (Sen. Brophy), also failed. CCLP actively opposed SB12-032 that would have required the Department of Health Care Policy and Financing to seek a federal waiver to allow alterations to Medicaid and CHP+ eligibility, services and cost sharing. Specifically, this bill would have required the state to seek a waiver to manage eligibility, establish an asset test, increase cost sharing, and other mechanisms that in our view would have discouraged and reduced enrollment in the Medicaid program. Of equal significance, the bill would have required the state to negotiate with the federal government for block grant payments for the programs, locking Colorado into a fixed payment structure that would not have accounted, among other factors, for medical inflation, emergencies or recessions. CCLP testified in opposition.
This bill was one of several that touted the need for increased state flexibility and reduced federal oversight. However, this bill’s primary purpose was to cut access to and funding for Medicaid benefits. CCLP opposed the bill because it would have prevented countless low-income Coloradans from accessing the critical health care services they need. Furthermore, it would have jeopardized a significant amount of federal funding that supports Colorado’s Medicaid program. SB12-032 failed in committee.
SB12-085, Reducing General Fund Expenditure (Sen. Mitchell), was another defensive success. CCLP actively opposed this bill that would have returned Medicaid and CHP+ eligibility and services to 2006 levels. The bill targeted recent expansions to children, low-income parents, working people with disabilities, adults without dependent children making less than $90 a month, certain foster care children and lawfully present aliens. It also sought to eliminate the state’s ability to provide continuous Medicaid eligibility and presumptive eligibility. The programs and groups designated by the bill for cuts are funded using revenue generated by Amendment 35 (tobacco tax) and the hospital provider fee (HB09-1293). None of the programs described are funded by General Fund expenditures. The state would have lost $115 in hospital provider fee matching dollars if the bill had passed. In addition, the federal Patient Protection and Affordable Care Act (PPACA) requires states to maintain their Medicaid and CHP+ eligibility levels as they were on March 23, 2010. States that fail to comply risk the loss of all federal Medicaid and CHP+ funding. CCLP testified against SB12-085.
SB12-108, Dental Coverage for Pregnant Women, (Sen. Nicholson/Rep. Summers), would create a defined dental benefit for pregnant women in the Medicaid program. The bill requires a report on the program to the legislature and also allows for the evaluation of health outcomes resulting from the addition of the dental benefit. Better oral health for pregnant moms in the Medicaid program could reduce the number of preterm births and low birth weight babies, and result in better health outcomes for both mom and baby, as well as lower costs to the system. The bill died on the House calendar along with about 30 bills on the eve of sine die, but efforts to resurrect the bill were still underway at the time of this writing.
SB12-159, Evaluation Children with Autism Medicaid Waiver (Sen. Hudak/Rep. Kerr). CCLP actively amended SB12-159, which requires regular evaluations of children receiving long-term care services and supports through the Medicaid autism waiver program. These evaluations are intended to provide information about the effectiveness of treatment under the autism waiver program and also to ensure that services and supports under the program are being directed toward children with the greatest needs. The bill also establishes a prioritization process for moving those children with the greatest need for services off of the wait list and into the waiver program. Because the children with autism waiver program caps the number of children who can get onto a waiver, this bill will help to ensure that the highest needs children receive services. CCLP worked with proponents on technical amendments, particularly related to federal Medicaid maintenance of effort requirements. The bill had passed third reading in the House at the time of this writing.
HB12-1281 Medicaid Payment Reform Pilot Program (Reps. Young, Gerou/ Sens. Steadman, Roberts), passed. CCLP supported House Bill 12-1281, which authorizes the Department of Health Care Policy and Financing to accept applications for payment reform projects. These projects are designed to move Medicaid away from the traditional fee-for-service payment structure, with the goal of improving quality and reducing costs through enhanced coordination of care. Projects could include a global payment system, in which a fixed payment covers all of a patient’s health care needs, or other forms of payment reform, such as risk sharing or the use of incentive payments. Projects will take place within the structure of the state’s Accountable Care Collaborative (ACC) Program, an existing delivery reform system which focuses on increased care coordination. Current contractors in the ACC Program and medical providers within each region of the ACC Program are eligible to bid for payment reform project contracts. We remain concerned, however, that the bill was not fully funded. Funding is required for HCPF to implement the effort appropriately and hire sufficient expert and technical help to develop an RPF and negotiate contracts. We hope the remaining approximately $90,000 in funding not appropriated will be made available through the supplemental budget process.
Health Care Access
SB12-053, Colorado Health Benefit Exchange Repeal (Sen. Neville/Rep. Looper), failed. This bill would have repealed the Colorado Health Benefit Exchange Act (SB11-200) if PPACA were to be repealed or if any part of PPACA were deemed unconstitutional by the U.S. Supreme Court. CCLP actively supported SB11-200 that established the Colorado Health Benefit Exchange (COHBE) and considers the COHBE to be an important mechanism for making the purchase of health coverage more accessible, transparent and affordable.
SB12-054, No Retaliation against Health Employees (Sen. Boyd), and SB12-093, Notice of Hospital Services not provided on Religious Grounds (Sen. Boyd), both failed. CCLP strongly supported these two bills, which were designed to protect consumer access to all medical procedures without restriction for religious or moral reasons. These bills would have protected professional staffs and employees and informed patients when procedures involving reproductive choices, counseling regarding STDs, and stem cell issues were involved. The first, SB12-54, would have protected medical professionals performing procedures in good faith against retaliation by their employers. It was withdrawn by the sponsor in the Senate. The second, SB12- 93, would have required hospitals to post and circulate to patients a list of procedures they were not offering due to religious or moral reasons. It passed the Senate but was defeated in the House State Affairs Committee.
Health Care and the Budget
We were troubled by the tone of the legislative discussion this year with its focus on pitting Medicaid against other critical programs. Medicaid ensures that hundreds of thousands of low-income, disabled and elderly Coloradans have access to health care. The idea that Medicaid must be cut in order for children to have an adequate education or that either the needs of either Colorado’s children or seniors are more or less important highlights the inadequacy of Colorado’s revenue situation. We are grateful that, by the end of the session and due in large part to increased revenue projections, the discussion moved away from pitting our children against our seniors. However, we still need real and lasting solutions that balance our health and education needs and move Colorado forward.
With respect to specific issues in the budget, CCLP had several concerns that were resolved. We were concerned that savings projections for ACCs were unrealistic. HCPF’s goal was to realize seven percent savings on the population participating in the ACC program. Mid-year funding cuts because of inaccurate savings projections would, we believed, put clients or provider payments at risk. The final budget bill counted approximately $4.9 million net savings from the ACCs. It also appropriated $4.9 million for providing services to an additional 173 Coloradans with developmental disabilities. In addition, we were not supportive of HCPF’s proposal to increase Medicaid cost sharing, nor were we supportive of the idea of limiting hours for home health care for people needing acute in home care. Neither proposal went forward.
The legislature did pass HB12-1339 (Rep. Becker/Sen. Lambert) which appropriates $23 million toward the improvement and modernization of the Computer Benefits Management System (CBMS), which handles eligibility and enrollment for public benefits programs like Medicaid, CHP+ and food assistance. This is the single biggest appropriation and most significant system improvement since CBMS launched in 2004. The bill appropriates nearly $9 million in funding for the current fiscal year and an additional $14 million for fiscal year 2012-13 to the Governor’s Office of information Technology (OIT), Health Care Policy and Financing (HCPF) and the Department of Human Services (DHS). The improvements should allow HCPF to draw down an enhanced matching rate from the federal government that has been designated for upgrading eligibility systems. If the state’s improvement plan is approved by the federal Centers for Medicare and Medicaid Services (CMS), CMS will provide 90 percent of certain development costs and the state will provide the remaining 10 percent. The changes are expected to, among other things, improve the online application to allow for real time eligibility determinations, improve and streamline client correspondence, upgrade the infrastructure and improve CBMS’s interoperability with other systems.
HB12-1175, Colorado-specific Solutions instead of Fed Regulation (Stephens/Cadman), did not survive. CCLP actively opposed HB 12-1175 that would have encouraged state agencies to seek waivers from federal statutory and regulatory authority whenever possible. The bill encouraged state agencies to enact state rules and regulations in place of federal statutes and rules. State agencies would have been required to submit an annual report to the legislature outlining every opportunity available to waive federal statutory or regulatory authority and whether the agency sought that waiver. CCLP opposed the bill because it was another attempt to avoid federal minimum requirements for public benefits programs, such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and many others.
HR12-1003, Federal Convention to Repeal Federal Health Law (Rep. Balmer), passed the House. In a move that will ultimately have no effect whatsoever on federal health reform, this House resolution urges Congress to call a convention under Article V of the U.S. Constitution for the sole purpose of repealing PPACA.
SB12-167, Higher Education Student Health Trusts and Plans (Rep. Balmer), did not survive. CCLP raised significant concerns about SB12-167, which was brought by the University of Colorado, and would have allowed public institutions of higher education to provide self-funded health coverage to students and their dependents through the newly-established student health trust. The purpose of the bill was to provide higher quality health coverage for students and their dependents than what is currently available through commercial insurance carriers that offer student-specific health insurance products. Currently, commercially-available student health insurance products are similar to catastrophic plans, offering poor benefits packages at costs that are generally not considered to be a good value. However, CCLP had a number of significant concerns with the manner in which CU wished to address these problems through SB 167:
- The bill would have allowed student health trusts to offer health coverage to students free of any state or federal regulatory oversight. The bill specifically exempted student health trusts from regulation and licensure requirements by the Colorado Division of Insurance. Furthermore, student health trust plans would not be subject to federal oversight under the Employee Retirement Income Security Act (ERISA) since these plans are for students, not employees.
- Student health trust plans would not have to comply with the consumer protections for student health plans under PPACA. PPACA contains numerous consumer protections that apply to student health insurance products, including no annual/lifetime dollar limits, no rescissions based on health status, preventive services free of cost-sharing, and many others. However, PPACA does not require self-funded plans to comply with these consumer protections.
The bill was lost on second reading in the Senate at the sponsor’s request, after it was amended to become a study.